BACKGROUND: The tobacco industry has marketed Electronic Nicotine Delivery Systems (ENDS) as alternatives with "reduced risk potential," claiming they allow users to "smoke anywhere." However, academic research suggests that ENDS are not recommended for smoking cessation and highlight significant health risks. Brazil banned the commercialization, importation, and advertising of ENDS since 2009.
This study aimed to explore the perceptions of ENDS users regarding their motivations for adoption, the associated risks, and their consumption practices.
METHODS: Twenty focus groups were conducted across five cities in Brazil, with two groups in each city: one of young adults (18-28 years) and another of adults (29+ years). All participants were ENDS users, and 60 informants from social classes A and B1 were included. The analysis involved thematic coding, iterative refinement, member checks, and triangulation across groups and regions.
RESULTS: Participants cited various reasons for adopting ENDS, including the lack of unpleasant odors, which facilitated social interaction, and the variety of flavors that allowed for customized experiences. Many users considered themselves non-smokers and some felt a sense of social status from using a "trendy" product, traditionally associated with conventional cigarettes.
Users believe that ENDS posed fewer health risks than conventional cigarettes. Practical benefits, such as portability, the absence of ash, and the ability to use ENDS in places where smoking is prohibited, were also highlighted.
CONCLUSIONS: This study revealed a significant lack of understanding about the harms of ENDS. Many users believed they were harmless and underestimated social risks, thinking they could use ENDS in places where smoking is prohibited. Among smokers, ENDS were seen as an alternative to quitting. This confusion could lead to harm, especially if smokers believe ENDS are a safer option or if young people adopt them as a trend.